Table 3.142.
Main antipsychotic drugs used to treat schizophrenia
| Antipsychotic drug | Examples | Features |
|---|---|---|
| Phenothiazines with pronounced sedative effects, but moderate antimuscarinic and extrapyramidal effects | Chlorpromazine | If there is considerable anxiety or hyperactivity, chlorpromazine is most commonly used but parenteral use of fluphenazine enanthate or decanoate, pipothiazine palmitate or zuclopenthixol decanoate by bi-weekly injection overcomes compliance difficulties |
| Methotrimeprazine | ||
| Promazine | ||
| Phenothiazines with low extrapyramidal effects, moderate sedative and antimuscarinic effects | Pericyazine | Fewer extrapyramidal effects than other phenothiazines. Thioridazine may be cardiotoxic |
| Pipotiazine | ||
| Thioridazine | ||
| Piperazine phenothiazines, with low sedative and antimuscarinic activity but high extrapyramidal effects | Fluphenazine | If no sedation is needed piperazine phenothiazines may be given but may have pronounced extrapyramidal effects and may worsen depression |
| Perphenazine | ||
| Prochlorperazine | ||
| Trifluoroperazine | ||
| Butyrophenones | Benperidol | Useful mainly for violent patients |
| Droperidol | ||
| Haloperidol | ||
| Thioxanthines | Flupenthixol/flupentixol | Extrapyramidal effects common |
| Zuclopenthixol | ||
| Atypical antipsychotics | Clozapine | All, apart from clozapine, are first-line treatment for newly diagnosed schizophrenia. Clozapine is used for resistant cases; it does not produce tardive dyskinesia but has significant antimuscarinic effect and can cause agranulocytosis |
| Amisulpride | ||
| Olanzapine | ||
| Quetiapine | ||
| Risperidone | ||
| Sertindole | ||
| Zotepine | ||
| Diphenylbutylpiperidines | Fluspirilene |
Danger of sudden unexplained, probably cardiac, death |
| Pimozide | ||